﻿<div id="editModal" tabindex="-1" class="modal fade in" aria-hidden="true">
    <div class="modal-dialog">
        <div class="box box-info">
            <div class="box-header with-border">
                <h5 class="box-title" id="Title"></h5>
                <button class="close" aria-label="Close" type="button" data-dismiss="modal">
                    <span aria-hidden="true">×</span>
                </button>
            </div>
            <form class="form-horizontal">
                <input type="hidden" id="Id" />                
                <input type="hidden" id="CreatedBy" />
                <input type="hidden" id="CreatedOn" />  
                <div class="box-body">
                    <div class="form-group">
                        <label class="col-sm-2 control-label" for="">预约部门</label>
                        <div class="col-sm-10">
                            <input id="DepartmentId" type="hidden">
                            <input class="form-control" id="DepartmentId1" type="text" disabled>
                        </div>
                    </div>
                    <div class="form-group">
                        <label class="col-sm-2 control-label" for="">姓名</label>
                        <div class="col-sm-10">
                            <input class="form-control" id="Name" type="text" disabled>
                        </div>
                    </div>
                    <div class="form-group">
                        <label class="col-sm-2 control-label" for="">联系电话</label>
                        <div class="col-sm-10">
                            <input class="form-control" id="Tel" type="text" disabled>
                        </div>
                    </div>
                    <div class="form-group">
                        <label class="col-sm-2 control-label" for="">办证类型</label>
                        <div class="col-sm-10">
                            <input class="form-control" id="BZType" type="text" disabled>
                        </div>
                    </div>
                    <div class="form-group">
                        <label class="col-sm-2 control-label" for="">上门地址</label>
                        <div class="col-sm-10">
                            <input class="form-control" id="Address" type="text" disabled>
                        </div>
                    </div>
                    <div class="form-group">
                        <label class="col-sm-2 control-label" for="">预约时间</label>
                        <div class="col-sm-10">
                            <input class="form-control" id="YYtime" type="datetime" disabled>
                        </div>
                    </div>
                    <div class="form-group">
                        <label class="col-sm-2 control-label" for="">是否办理</label>
                        <div class="col-sm-10">
                            <input id="IsBL" type="checkbox"> 选中则办理
                        </div>
                    </div>
                    <div class="form-group">
                        <label class="col-sm-2 control-label" for="inputPassword3">备注</label>
                        <div class="col-sm-10">
                            <input class="form-control" id="Remarks" type="text" placeholder="办理结果或未理原因">
                        </div>
                    </div>
                    
                    
                </div>
                <div class="box-footer">
                    <div class="pull-right box-tools">
                        <button id="btnSave" class="btn btn-primary" type="button">保存</button>
                        <button class="btn btn-default" type="button" data-dismiss="modal">取消</button>
                    </div>
                </div>
            </form>
        </div>
    </div>
</div>